Measuring National Immunization System Performance: A Systematic Assessment of Available Resources

Area of Science:

• Public Health
• Health Systems Research
• Immunization Programs

Background:

• Vaccination coverage is a common but insufficient metric for evaluating immunization performance.
• Assessing immunization systems' underlying components is complex, with various monitoring and evaluation (M&E) resources available.
• Understanding how immunization system performance is measured is crucial for improving global health outcomes.

Purpose of the Study:

• To review and analyze existing monitoring and evaluation (M&E) resources for immunization systems.
• To identify national-level indicators used to measure the performance of immunization systems and their components.
• To understand the scope and limitations of current M&E tools in the field of immunization.

Main Methods:

• A systematic review of peer-reviewed and gray literature published since 2000.
• Identification of M&E resources containing national-level indicators for immunization system components.
• Categorization and narrative summary of indicators by system component (governance, financing, etc.) and outcomes.

Main Results:

• Twenty resources with 631 distinct indicators were identified.
• Immunization program outcomes, primarily vaccination coverage, were the most common indicators.
• Indicators for vaccine logistics were prevalent, while those for regulation and demand generation were least common.
• Significant heterogeneity was observed in assessing information systems and workforce performance.
• Key indicators for adult vaccination, data use, equity, safety surveillance, and public health workforce availability were notably absent.

Conclusions:

• Considerable variability and gaps exist in indicators for assessing immunization system performance.
• Policymakers should tailor M&E resources to specific contexts for better insights.
• Improving data use in decision-making is essential for enhancing immunization programs.